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Publications (3)1.33 Total impact

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    ABSTRACT: We evaluated the outcomes of patients with elbow heterotopic ossification (HO) who underwent surgical intervention. Our goal was to elucidate differences in outcome of surgical treatment between those patients with traumatic brain injury, direct elbow trauma, or combined etiologies. In addition, we used regression analysis to adjust for confounding factors (such as age, gender, preoperative range of motion [ROM], location of HO, chronicity of HO [ie, time from HO formation to surgery], and whether motor control was spastic or normal) on the relationship between surgical outcome and etiology. We reviewed 60 patients (64 elbows) surgically treated for heterotopic ossification. A total of 42 patients had trauma as the primary etiology, 15 had traumatic brain injury, and 7 had combined etiologies. All had pain or functional limitations at presentation. All patients had surgical resection of their HO. Functional and ROM outcomes were recorded. Mean preoperative arc of motion for the entire cohort was 57° (range, 0° to 150°). Mean postoperative arc for the entire cohort was 106° (range, 0° to 145°) at a mean follow-up of 44 months (range, 21-72 mo), demonstrating a significant gain. Average gain, in arc of motion was 49° (range, 10° to 140°). Gains in motion were not significantly different in any individual etiologic group. A total of 6% of cases were complicated by infection, 13% of cases had recurrence of HO, and 11% of cases required repeat surgery for infection or recurrence. Preoperative ROM was an important independent predictor of final range achieved and gain in ROM after surgical intervention. Recurrence rates were higher in patients with neurologic involvement. Postoperative stiffness was related to preoperative stiffness, delay of surgery longer than 12 months, and anterior location of the HO. Surgical excision of heterotopic bone about the elbow results in significant gains in ROM regardless of etiology. The likelihood of recurrence is higher in patients with central nervous system injuries than in patients with purely localized trauma.
    The Journal of hand surgery 04/2011; 36(5):798-803. · 1.33 Impact Factor
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    ABSTRACT: Background: Patients with paralytic poliomyelitis or post-polio syndrome can develop osteoarthritis with time. Most clinicians are hesitant to offer joint arthroplasty as an option because long-term outcomes are unknown. The purpose of this study was to determine the feasibility of performing total joint arthroplasties in arthritic hips and knees in adult patients with post-polio syndrome and to evaluate outcomes. Methods: All adult patients with post-polio syndrome who had lower extremity joint arthroplasty for osteoarthritis at our institution were reviewed. A detailed physical examination, manual muscle testing, joint range of motion, spine evaluation, gait evaluation and orthotic assessment were performed on all patients. Appropriate scoring systems were used to evaluate the outcomes, including the Harris Hip Scoring System (HHSS) and the Knee Society Scores (KSS). Results: Seventeen symptomatic patients with osteoarthritis underwent 19 joint arthroplasties. Mean age at surgery was 66.5 years. All patients experienced notable pain relief after surgery. The mean KSS improved from 28 to 88 (10 cases) and the mean HHSS improved from 94 to 173 (nine cases). The functional ambulation level improved an average of one grade in all patients. No radiographic evidence of loosening or wear of the prosthesis was observed at final follow-up (mean 92 months; 26–180). Conclusions: Total joint arthroplasty can be a safe and effective treatment for osteoarthritis in patients with post-polio syndrome with predictable resolution of pain, improved function and preservation of muscle strength.
    Current Orthopaedic Practice 04/2010; 21(3):273-281.
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    ABSTRACT: Background: Cerebral palsy denotes a syndrome complex covering a group of nonprogressive, but often changing, motor impairment secondary to lesions or anomalies in the brain arising in the early stages of its development. Traditional teaching was that surgical interventions in adult patients are less successful and fraught with more complications. We reviewed all our adult patients with cerebral palsy who were surgically treated over 6 years to assess their outcomes. Methods: Goals for surgical intervention were based on the preoperative ambulatory and functional status of the patient. Of the 114 patients treated, 105 patients had 508 lower extremity procedures, while 57 patients had 144 upper extremity procedures. A total of 652 orthopaedic procedures were performed, with a mean of four procedures (range, 1 to 12). Mean follow-up was 38 months (range, 24 to 72 mo). Results: All patients underwent successful surgical correction of deformities or muscle imbalance with improvement in function, ambulation or both. There was a notable decrease in the use of orthoses, although many patients were prescribed braces and were advised to continue them. There were no recurrences or repeat surgeries performed until latest follow-up. Conclusions: A “goal-oriented approach” is important while embarking on musculoskeletal procedures in adult patients with cerebral palsy. Our results present a promising outlook towards neuro-orthopaedic surgical intervention in adult patients with cerebral palsy. Level of Evidence: Level III, therapeutic study.
    Current Orthopaedic Practice 12/2009; 21(1):71-76.